Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication
Phyo Kyaw Myint1, Chun Shing Kwok2, Christine Roffe2
1From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology, Royal Jubilee Hospital, Glasgow, UK (C.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.F.L.); and Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.). phyo.myint@abdn.ac.uk.
Insights
Stroke after percutaneous coronary intervention (PCI) is rare but serious. This study found stroke significantly increases mortality and adverse cardiovascular events, regardless of PCI type or stroke subtype.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Stroke is a serious complication following percutaneous coronary intervention (PCI).
- Determinants and outcomes of stroke after PCI in various clinical settings are not well-documented.
Purpose of the Study:
- To investigate stroke risk factors and outcomes after PCI.
- To analyze stroke occurrence based on procedure type and clinical setting.
Main Methods:
- Utilized the British Cardiovascular Intervention Society (BCIS) database.
- Analyzed data from 560,439 patients undergoing PCI in England and Wales (2006-2013).
- Examined determinants of ischemic and hemorrhagic stroke, and associated 30-day mortality and major adverse cardiovascular events (MACE).
Main Results:
- 705 stroke cases (80% ischemic) were recorded.
- Stroke after elective PCI or PCI for acute coronary syndrome (ACS) significantly increased 30-day mortality and MACE.
- No significant difference in adverse outcomes between elective PCI and ACS settings.
Conclusions:
- Stroke after PCI, though uncommon, is linked to worse outcomes.
- Identified stroke risk factors and prognosis post-PCI, aiding informed patient counseling.
- Findings emphasize the independent association of stroke with mortality and MACE in both elective and ACS settings.
Background And Purpose:
Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented.
Methods:
The British Cardiovascular Intervention Society (BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization).
Results:
A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43-67.05) and 21.05 (13.25-33.44) for elective and 5.00 (3.96-6.31) and 6.25 (5.03-7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64-2.43) and 0.63 (0.35-1.15), respectively.
Conclusions:
Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur.
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